Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.

Depression and chronic heart failure in the elderly： an intriguing relationship

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

Additive Benefits of Twice Forest Bathing Trips in Elderly Patients with Chronic Heart Failure

Chronic heart failure （CHF）, a clinical syndrome resulting from the consequences of various cardiovascular diseases （CVDs）, is increasingly becoming a global cause of morbidity and mortality. We had earlier demonstrated that a 4-day forest bathing trip can provide an adjunctive therapeutic influence on patients with CHF. To further investigate the duration of the impact and the optimal frequency of forest bathing trips in patients with CHF, we recruited those subjects who had experienced the first forest bathing trip again after 4 weeks and randomly categorized them into two groups, namely, the urban control group （city） and the forest bathing group （forest）. After a second 4-day forest bathing trip, we observed a steady decline in the brain natriuretic peptide levels, a biomarker of heart failure, and an attenuated inflammatory response as well as oxidative stress. Thus, this exploratory study demonstrated the additive benefits of twice forest bathing trips in elderly patients with CHF, which could further pave the way for analyzing the effects of such interventions in CVDs.

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

Effect of adjuvant levosimendan therapy on neuroendocrine hormones and cytokines in elderly patients with chronic heart failure

Objective: To discuss the effect of adjuvant levosimendan therapy on neuroendocrine hormones and cytokines in elderly patients with chronic heart failure. Methods: A total of 100 elderly patients with chronic heart failure who were treated in the hospital between March 2014 and March 2017 were divided into control group and levosimendan group by random number table, each with 50 cases. Control group received clinical routine therapy for chronic heart failure, and levosimendan group received routine therapy combined with adjuvant levosimendan therapy. The differences in serum levels of RAAS indexes, thyroid hormones, myocardial damage indexes and endothelial function indexes were compared between the two groups before and after treatment. Results: At T0, there was no statistically significant difference in serum levels of RAAS indexes, thyroid hormones, myocardial damage indexes and endothelial function indexes between the two groups. At T1, serum RAAS indexes PRA, AngⅡ and ALD levels of levosimendan group were lower than those of control group;serum thyroid hormones TT3, TT4, FT3 and FT4 levels of levosimendan group were higher than those of control group;serum myocardial damage indexes cTnⅠ, H-FABP and NT-proBNP levels of levosimendan group were lower than those of control group;serum endothelial function index NO level of levosimendan group was higher than that of control group while ET-1 level was lower than that of control group. Conclusion: Adjuvant levosimendan therapy for elderly patients with chronic heart failure can effectively adjust the secretion of neuroendocrine hormones and reduce the myocardial and vascular endothelial damage.

Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age: 81.9 years) or control group (n = 36;25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

沙库巴曲缬沙坦钠片治疗慢性心力衰竭的效果

目的分析沙库巴曲缬沙坦钠片治疗慢性心力衰竭的临床效果。方法选择2021年12月—2022年12月六盘水市人民医院收治的186例慢性心力衰竭患者纳入研究。按照随机数字表法分为新式组和传统组,各93例。传统组使用马来酸依那普利片治疗,新式组使用沙库巴曲缬沙坦钠片治疗。比较2组心功能指标[左心室射血分数(left ventricular ejection fraction,LVEF)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)及血浆脑钠肽(brain natriureticpeptide,BNP)]、治疗效果、预后情况。结果干预后,新式组LVEF水平[(48.36±5.29)%]高于传统组[(46.29±5.26)%],LVESD、LVEDD、BNP水平[(38.63±4.25)mm、(50.26±4.93)mm、(133.36±12.25)ng/L]低于传统组[(41.26±2.25)mm、(54.26±4.29)mm、(159.63±20.36)ng/L],差异有统计学意义(P<0.05)。新式组治疗总有效率(97.85%)高于传统组(82.80%),差异有统计学意义(P<0.05)。新式组再入院率、不良心血管事件发生率(11.83%、16.13%)低于传统组(32.26%、37.63%),差异有统计学意义(P<0.05)。结论沙库巴曲缬沙坦钠片治疗慢性心力衰竭可达到良好的治疗效果,同时可改善心功能,降低再入院率、不良心血管事件发生率。

马来酸依那普利联合沙库巴曲缬沙坦对老年冠心病伴慢性心力衰竭患者心功能及炎性因子的影响

目的探讨马来酸依那普利联合沙库巴曲缬沙坦治疗对老年冠心病伴慢性心力衰竭患者心功能、炎性因子水平及安全性等的影响。方法将90例老年冠心病伴慢性心力衰竭患者随机分为两组,各45例。对照组患者采用马来酸依那普利治疗,观察组患者采用马来酸依那普利联合沙库巴曲缬沙坦治疗,观察6个月。比较两组患者的临床疗效、不良反应发生率,以及治疗前后血清可溶性细胞间黏附分子-1(sICAM-1)水平、可溶性血管细胞黏附分子-1(sVCAM-1)水平、心功能[氨基末端B型利钠肽原(NT-proBNP)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]、血压[收缩压(SBP)、舒张压(DBP)]、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)]水平。结果观察组患者临床疗效总有效率高于对照组(P<0.05)。治疗后,两组患者血清sICAM-1、sVCAM-1水平均较治疗前明显降低,且观察组低于对照组(P<0.01)。治疗后,两组患者NT-proBNP、LVEDD、SBP、DBP均较治疗前下降,LVEF较治疗前上升,且观察组优于对照组(P<0.05或0.01)。治疗后,两组患者TNF-α、IL-6和hs-CRP水平均较治疗前降低,且观察组低于对照组(P<0.01)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论马来酸依那普利联合沙库巴曲缬沙坦治疗老年冠心病伴慢性心力衰竭疗效显著,可改善患者心功能,降低血清sICAM-1、sVCAM-1水平,减轻炎症反应,安全性高,值得临床进一步推广。

沙库巴曲缬沙坦钠片治疗高原地区高血压慢性心力衰竭患者的临床效果

目的评价沙库巴曲缬沙坦钠片治疗高原地区高血压慢性心力衰竭(CHF)患者的临床效果。方法选取2017年10月至2018年2月在拉萨市人民医院门诊及住院诊治的因高血压导致的CHF患者96例。采用随机数字表法分为观察组(47例)和对照组(49例)。观察组在常规心力衰竭治疗基础上给予沙库巴曲缬沙坦钠片100 mg/次,2次/d口服;对照组则在常规心力衰竭治疗基础上给予马来酸依那普利10 mg/次,2次/d口服,2组均治疗6个月。主要观察指标包括左心室射血分数(LVEF)、6 min步行距离(6MWD),次要观察指标包括心血管不良事件(总死亡、心源性死亡、因心力衰竭再入院等)、收缩压、估算肾小球滤过率(e GFR)、血钾水平等。结果治疗6个月后,观察组LVEF、6MWD大于对照组[(38±4)%比(36±4)%、(325±70) m比(274±72) m],差异均有统计学意义(均P <0. 05)。观察组、对照组治疗后收缩压均较治疗前明显下降,差异均有统计学意义(均P <0. 05),但治疗后2组比较差异无统计学意义(P> 0. 05)。观察组和对照组e GFR、血钾组内治疗前后比较差异均无统计学意义(均P> 0. 05),治疗后2组比较差异亦无统计学意义(P> 0. 05)。6个月内观察组因心力衰竭再入院率低于对照组[21. 3%(10/47)比42. 9%(21/49)],差异有统计学意义(P <0. 05),2组患者总死亡率及心源性死亡率差异无统计学意义[2. 1%(1/47)比2. 0%(1/49)、2. 1%(1/47)比2. 0%(1/49)](P> 0. 05)。结论沙库巴曲缬沙坦钠片较依那普利能改善高原地区高血压CHF患者的左心功能,提高运动耐力及生活质量,减少疾病复发。

马来酸依那普利叶酸片治疗老年慢性心力衰竭的疗效及对血清sST2、Nexilin、NF-κB的影响

目的:探讨马来酸依那普利叶酸片治疗老年慢性心力衰竭的疗效及对血清可溶性ST2(sST2)、Nexilin、NF-κB的影响。方法:选取2016年2月至2017年2月海南医学院第一附属医院收治的老年慢性心力衰竭患者120例,采用随机数字表法分为研究组和对照组,每组60例。对照组采用依那普利片进行治疗,研究组采用马来酸依那普利叶酸片进行治疗。观察两组患者心脏功能的变化、治疗有效率、不良反应以及心血管损伤标志物sST2、Nexilin、NF-κB水平。结果:治疗后,研究组患者的每搏输出量(SV)和左室射血分数(LVEF)显著高于对照组,左心室收缩末容量指数(LVESVI)和左心室舒张末期容积指数(LVEDVI)显著低于对照组(P<0.05);研究组患者的治疗有效率(90.00%)显著高于对照组(73.33%)(P<0.05)。治疗前,两组患者血清sST2、Nexilin、NF-κB水平均无明显差异(P>0.05);治疗后,两组患者的sST2、Nexilin、NF-κB水平均显著下降,且研究组明显低于对照组(P<0.05)。两组均无不良反应发生。结论:马来酸依那普利叶酸片治疗老年慢性心力衰竭的疗效显著,且安全性高,其通过降低患者血清sST2、Nexilin、NF-κB水平而起到心功能保护的作用。

美托洛尔联合依那普利治疗慢性充血性心力衰竭的疗效观察

目的:探讨美托洛尔联合依那普利治疗慢性充血性心力衰竭(CHF)的临床效果。方法:将我院CHF患者60例随机分为观察组和对照组,对照组给予常规综合治疗,在此基础上观察组给予美托洛尔联合依那普利治疗,评估两者治疗效果。结果:治疗后两组患者SV、CO、LVEF均优于治疗前(P<0.05)。治疗后观察组患者SV、CO、LVEF均优于对照组(P<0.05)。观察组总有效率为93.33%,对照组为73.33%,两者比较差异具有统计学意义(P<0.05)。两组均无明显的治疗副反应产生。结论:美托洛尔联合依那普利治疗CHF的临床效果明确,副作用少,值得应用。

无创血流动力学监测可用于对老年慢性心力衰竭患者心功能的评价

目的通过对老年慢性心力衰竭患者无创血流动力学监测,并与美国纽约心脏病学会(NYHA)心功能分级做对比分析,初步评价判定心功能分级的可靠性。方法选取我院自2004年4月～2005年9月1日收治于老年心血管病科的冠心病、高血压病、扩张型心肌病等患者共120例,按NYHA分级分为Ⅰ、Ⅱ、Ⅲ、Ⅳ共4组,应用Bioz.com无创血流动力学监测得到16种血流动力学参数,进行统计学分析。结果①心输出量(CO)、心排血指数(CI)、左室每博作功指数(LVSWI)、左心作功指数(LCWI)4项参数值按NYHA分级Ⅰ～Ⅳ组有逐渐减低趋势(P<0.05);②每博输出量(SV)、每博输出指数(SI)、速率指数(VI)按NYHA分级Ⅰ、Ⅱ组间,Ⅲ、Ⅳ组间无显著差异,但Ⅰ、Ⅱ组与Ⅲ～Ⅳ组间有明显减低趋势(P<0.05);外周阻力(SVR)、外周阻力指数(SVRI)按NYHA分级Ⅰ、Ⅱ组间,Ⅲ、Ⅳ组间无显著差异,但Ⅰ、Ⅱ组与Ⅲ、Ⅳ组间有明显增高趋势(P<0.05);③胸部液体含量(TFC)、收缩时间比率(STR)按NYHA分级Ⅰ、Ⅱ、Ⅲ组间无显著差异,但Ⅳ组与其他各组比较有明显增高趋势(P<0.05)。结论无创血流动力学监测到的血流动力学参数可作为评估慢性心力衰竭临床分级标准的量化指标。

依那普利与缬沙坦对慢性心力衰竭患者基质金属蛋白酶-9及左室重构的影响

目的探讨慢性心力衰竭(CHF)应用依那普利和(或)缬沙坦对调节细胞外基质降解和改善心室重构的作用。方法将90例CHF患者随机分为3组,每组30例。A组:依那普利10mg/d,B组:缬沙坦80mg/d,C组:依那普利10mg/d+缬沙坦80mg/d,均服药8周。治疗前后分别测定血清基质金属蛋白酶-9(MMP-9)及超声心动图指标〔左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)和左室射血分数(LVEF)〕。结果 (1)3组CHF患者治疗后MMP-9及超声心动图指标比较,差别均有统计学意义(P<0.01);CHF患者MMP-9与LVEF呈负相关(r=-0.355,P=0.001),与LVEDV呈正相关(r=0.346,P=0.001)。(2)3组患者治疗后血清MMP-9、LVESV、LVEDV均较治疗前减少,LVEF较治疗前均升高,差异有统计学意义(P<0.05)。(3)C组患者治疗后MMP-9、LVESV、LVEDV低于A、B组,LVEF高于A、B组,差异均有统计学意义(P<0.05);A、B两组MMP-9及超声心动图指标比较,差异均无统计学意义(P>0.05)。结论依那普利联合缬沙坦治疗CHF效果明显优于单用依那普利或缬沙坦治疗,能更有效地降低MMP-9质量浓度,调节基质金属蛋白酶,改善心室重构。

参附注射液配合伊那普利和倍他乐克治疗慢性充血性心力衰竭的临床研究

目的:探讨参附注射液配合伊那普利和倍他乐克对慢性充血性心力衰竭患者血浆脑钠肽(BNP)、血管紧张素Ⅱ(ATⅡ)、内皮素(ET)含量的影响。方法:采用随机临床对照观察方法,参附注射液配合伊那普利和倍他乐克治疗74例慢性充血性心力衰竭的患者为治疗组,以伊那普利和倍他乐克治疗78例为对照组,比较两组患者治疗前后心功能指标以及血浆脑钠肽(BNP)、血管紧张素Ⅱ(ATⅡ)、内皮素(ET)含量的变化,观察治疗后两组用药后不良反应及停药比例,判断临床疗效。结果:两组患者治疗后左室射血分数、左室舒张末期内径和每搏输出量较治疗前显著增加(P<0.01);与对照组比较,治疗后治疗组左室射血分数、每搏输出量有显著性差异(P<0.05);两组治疗后血浆BNP、ATⅡ、ET水平较治疗前显著下降(P<0.01);与对照组比较,治疗后治疗组血浆BNP、ATⅡ、ET水平有显著性差异(P<0.05);治疗组总有效率为89.2%,明显高于对照组(80.8%,P<0.05)。治疗组不良反应的发生率及停药比例明显少于对照组(P<0.05)。结论:参附注射液配合伊那普利和倍他乐克可有效调节内源性神经激素,改善心功能,减少副作用的发生,临床疗效优于伊那普利联用倍他乐克。

利心丸、曲美他嗪联合依那普利治疗老年风湿性心脏病合并慢性心力衰竭临床疗效及安全性观察

目的探讨利心丸、曲美他嗪联合依那普利治疗老年风湿性心脏病合并慢性心力衰竭的临床疗效。方法选择2015年2月至2016年2月于我院接受治疗的80例老年风湿性心脏病合并慢性心力衰竭病人作为研究对象,利用随机数字表法将其分为观察组和对照组,每组40例。对照组给予曲美他嗪联合依那普利治疗;观察组在对照组治疗基础上另给予利心丸治疗,各组的治疗时间均为3月。治疗后评价各组疗效;治疗前后分别检测各组病人心脏功能[左室收缩末内径(LVESD)、左房内径(LADD)、左室舒张末内径(LVEDD)和左室射血分数(LVEF)],一般心血管指标[心胸比、纽约心脏学会(NYHA)分级、舒张压及心率]。观察病人治疗期间出现的不良反应。结果观察组显效率及总有效率分别为40.0%及95.0%,均明显高于对照组(P<0.05)。观察组病人治疗后LVESD、LADD、LVEDD、心胸比、NYHA分级、舒张压、心率均明显低于对照组,而LVEF明显高于对照组(P<0.05);各组病人治疗期间均未出现严重不良反应。结论利心丸、曲美他嗪联合依那普利治疗老年风湿性心脏病合并慢性心力衰竭具有较好的临床疗效,值得开展深入研究。

比索洛尔联合依那普利、螺内酯治疗风湿性心脏病慢性心力衰竭的效果观察

目的 观察对比比索洛尔、依那普利联合螺内酯治疗风湿性心脏病慢性心力衰竭患者的有效性。方法 选取2015年6月-2016年6月我院收治的94例风湿性心脏病慢性心力衰竭患者作为研究对象,随机均分为实验组与对照组,每组各47例。对照组患者给予常规药物治疗,实验组患者则采用比索洛尔、依那普利联合螺内酯治疗,观察并比较两组患者的治疗效果。结果 实验组患者总有效率为95.75%（45/47）,明显高于对照组的82.98%（39/47）,差异有统计学意义（P〈0.05）;治疗后,实验组患者的LVESD、LVEDD及LVEF水平均明显优于对照组,差异有统计学意义（P〈0.05）。结论 采用比索洛尔、依那普利及螺内酯联合治疗风湿性心脏病慢性心力衰竭效果较好,值得进行进一步的研究及应用。

依那普利联合倍他乐克治疗慢性心衰的临床研究

目的探讨依那普利联合倍他乐克治疗慢性心衰(CHF)的临床效果。方法将我院CHF患者70例随机分为观察组和对照组,对照组给予常规治疗,观察组同时给予依那普利联合倍他乐克治疗,评估两组临床治疗效果。结果观察组患者总有效率明显高于对照组(P<0.05)。治疗后观察组患者EF、LVD、LVFS明显高于对照组(P<0.05)。治疗后观察组患者RDW明显低于对照组(P<0.05)。结论依那普利联合倍他乐克治疗CHF的临床效果明显,值得应用。

马来酸依那普利叶酸片联合阿托伐他汀治疗慢性心力衰竭的临床疗效

目的探究马来酸依那普利叶酸片联合阿托伐他汀治疗慢性心力衰竭的临床疗效。方法选取2014年10月至2017年4月收治的60例慢性心力衰竭患者,按随机数字表划分为研究组和对照组,每组30例。其中对照组予以马来酸依那普利叶酸片治疗,研究组予以马来酸依那普利叶酸片联合阿托伐他汀治疗。记录2组患者在治疗前及治疗后第6个月末的左心室射血分数(LVEF)、左心室收缩末径(LVESD)、左心室舒张末径(LVEDD)、NYHA心功能分级、N末端脑钠肽原(NT-proBNP)、肌钙蛋白T(cTnT)、同型半胱氨酸(Hcy)、6 min步行试验结果,并比较2组患者的临床疗效。结果治疗后,研究组患者的LVEF高于对照组(P<0.05),LVESD、LVEDD低于对照组(P<0.05)。研究组NYHA心功能分级优于对照组(P<0.05)。研究组NT-proBNP、cTnT、Hcy值小于对照组(P<0.05),6 min步行距离多于对照组(P<0.05)。研究组临床疗效优于对照组(P<0.05)。结论对于慢性心力衰竭患者而言,予以马来酸依那普利叶酸片联合阿托伐他汀治疗,可明显抑制心室重构,促进心功能恢复。

氯沙坦与苯那普利治疗老年慢性心功能不全的研究

目的 观察氯沙坦与苯那普利对老年慢性心功能不全 (CHF)的作用 ,探讨两者在老年CHF治疗中的地位。方法 共 13 5例患者入选 ,年龄均大于 60岁 ,心功能在Ⅱ～Ⅳ级之间 ,经心脏彩色多普勒超声检查证实左室射血分数在 5 0 %以下。在原有抗心力衰竭的基础上随机分入氯沙坦组 (2 5～ 5 0mg d)以及苯那普利组 (5～ 10mg d)。在治疗前及治疗后第 1、3、7、12周查血钾、肾功能及心电图。治疗前及治疗后第 12周时测定患者心脏结构和功能的变化。结果 苯那普利组和氯沙坦组治疗后第 12周时LVEDD(5 .97± 0 .41vs 6.3 6± 0 .43 ;5 .91± 0 .44vs 6.3 2± 0 .41)、LVEF(3 6.4± 4.3vs 3 0 .2± 4.9;3 7.8± 5 .1vs 2 9.7± 4.6)、CO(4 .62± 1.95vs 3 .3 5± 1.67;4.67± 1.82vs 3 .2 8± 1.72 )较入院时明显改善。但两组之间相比无显著差异。苯那普利组患者中共有 16例 (2 3 .19% )出现咳嗽、高钾血症、皮疹、局部血管神经性水肿等不良反应 ,氯沙坦组中仅有 1例 (1.5 % )患者出现低血压。结论 (1)氯沙坦及苯那普利均可以在一定程度上逆转老年CHF患者的左室重构 ,但两组之间相比无显著差异。 (2 )服用氯沙坦患者中咳嗽等不良反应发生率要明显低于苯那普利 ,耐受良好。

米力农联合氯沙坦治疗慢性肺源性心脏病心力衰竭的临床观察

目的观察米力农联合氯沙坦治疗慢性肺源性心脏病心力衰竭的疗效。方法随机将64例COPD导致的慢性肺源性心脏病心力衰竭患者分为治疗组及对照组,治疗组在常规治疗的基础上加用米力农静滴以及口服氯沙坦治疗,对照组则在常规治疗基础上,予以地高辛以及呋塞米口服作强心、利尿治疗。结果治疗组有效率90.6%,平均起效天数为6.6 d,对照组有效率为62.5%,平均起效天数为9.2d。治疗组无严重的不良反应,对照组则较为集中出现电解质紊乱、肾功能异常以及室性心律失常。结论米力农联合氯沙坦治疗慢性肺源性心脏病心力衰竭较传统治疗更为有效、安全。